Summarised from an article by Joan Brady, entitled 'Inside America's dying rooms', in The Independent (Mar 25th '97).
When Joan Brady's husband was dying in America, he was assigned to what was described as 'hospice-type care', but which turned out to consist in virtual warehousing of the dying, of a kind which could all too easily be coming to the U.K.
In what she calls a "gentle" description of the conditions she found when visiting her husband, Brady describes room after room of carelessly-attended patients, stinking from untreated bedsores, grey-faced and silent. Such 'hospices', whose staff are very badly paid and mostly unskilled, are referred to within the nursing-home trade as 'produce departments'; a ghoulish pun implying both the patients' treatment as 'vegetables' and the money which is made out of their perfunctory care. Records are habitually falsified, patients' medicines are smuggled out to the street drugs trade and theft of property is routine.
Nobody complains because the state inspectorate is understaffed, without adequate sanctions, and often corrupt. Doctors are able to write prescriptions and sign death certificates without setting foot inside, and the contemporary American terror of death means many relatives steer well clear.
The origins of these American 'dying rooms' can be traced back to the funding structure of American public medicine - in particular Prospective Payments and Diagnosis-Related Groups. Prospective Payment is an elaborate system of fixed payments for treatments; estimates paid in advance which have to cover whatever the care may actually turn out to cost. These payments are made according to an even more absurd structure of 470 Diagnosis-Related Groups. Every human ailment and known treatment is filed under one of these headings: the absurdity lies in the requirement that each patient must fall into one and one only of these groups, for which the cost of 'cure' - even for untreatable conditions - is rigidly set in advance. These fixed calculations provide for a certain number of days' care to effect a 'cure'. After that period, whether or not the patients remain ill, they are automatically re-categorised as 'non-acute' and there is no more money for treatment. The only provision for such unlucky people are the 'dying rooms' in private nursing homes.
Brady suggests that this approach to health funding is gaining ground in Britain. In 1994, the UK introduced new guidelines, with similarly nebulous distinctions between 'acute' and 'non-acute' patients, which allow hospitals to evict patients they can't afford to treat to private nursing homes. Brady notes with alarm that, at the same time, American hospital corporations have been buying into British nursing homes, and bringing with them the same profit-driven approach which produced the dying rooms. If such shockingly commercial warehousing of the dying has not yet appeared, it is not, Brady stresses, because regulation in Britain is any stricter than the US.
"Who is to say," she writes, "that there are obstacles to US corporations providing the British government with the same cheap - and wonderfully profitable - 'hospice-type care' they provide at home?"
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